Journal of Public Health

, Volume 18, Issue 6, pp 543–551 | Cite as

Whole-of-community approaches to reducing alcohol-related harm: What do communities think?

  • Suzanne Czech
  • Anthony P. Shakeshaft
  • Courtney Breen
  • Robert W. Sanson-Fisher
Original Article

Abstract

Aim

A whole-of-community approach can be defined as a range of intervention strategies simultaneously implemented across a whole community. One possibility for the lack of evidence for the effectiveness of this type of approach to reducing alcohol-related harm is that whole-of-community strategies to date have not examined whether this type of approach, relative to alternative strategies, is acceptable to communities.

Methods

The acceptability of a whole-of-community approach and a range of uni-dimensional strategies are examined using 3,017 survey responses from a random sample of 7,985 individuals (aged 18–62) across 20 rural communities in NSW, Australia, as part of a large-scale randomised controlled trial: the Alcohol Action in Rural Communities (AARC) project. Using the Australian Electoral Roll, the sample was selected to reflect specific characteristics (i.e., gender and age) of each participating town as defined in the Australian Bureau of Statistics 2001 census.

Results

Relative to other commonly implemented intervention strategies, the whole-of-community approach acceptability rating (85.5%) was statistically significantly greater than increased random breath testing (80.7%), pharmacist information (76.2%) and workplace training (77.0%), and less than increased pub/club compliance (95.8%), high-school programs (96.2%), increased police enforcement (89.5%) and hospital-based advice (88.6%). Intervention acceptability ratings were not associated with exposure to the suggested intervention with two exceptions: those exposed to pub/club compliance provided a lower acceptability rating, while those exposed to workplace training/policies provided a higher acceptability rating.

Conclusions

The high level of public support for alcohol interventions and the relatively low exposure to such interventions suggest scope for increasing awareness of intervention activity in communities and implementing a coherent whole-of-community approach.

Keywords

Alcohol Community-support Community-intervention Public health Australia 

Notes

Acknowledgments

This study was supported by a grant from the Alcohol Education and Rehabilitation Foundation (AERF), as part of the Alcohol Action in Rural Communities (AARC) project (Australian Clinical Trials Registry Number 012607000123448). The authors thank Barbara Toson for her assistance with selecting the most appropriate statistical analyses to interpret our findings.

Conflict of Interest

All authors declare that they have no conflict of interest.

References

  1. Australian Bureau of Statistics (ABS) (2001) 2001 Census data: Australian Bureau of StatisticsGoogle Scholar
  2. Australian Institute of Health and Welfare (AIHW) (2004) National Drug Strategy Household Survey: first results. Drug Statistics Series 20, Cat. no. PHE 98. Canberra, AIHWGoogle Scholar
  3. Australian Institute of Health and Welfare (2008) 2007 National Drug Strategy Household Survey: State and territory supplement. Drug Statistics Series no. 21, Cat. no. PHE 102. Canberra, AIHW. Available from: www.aihw.gov.au/publications/index.cfm/title/10670
  4. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez A (2007) The Burden of Disease and Injury in Australia, 2003. PHE 82. Canberra, AIHWGoogle Scholar
  5. Beich A, Thorsen T, Rollnick S (2003) Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis. BMJ 327:536–542CrossRefPubMedGoogle Scholar
  6. Berkowitz B (2001) Studying the outcomes of community-based coalitions. Am J Community Psychol 29:213–227CrossRefPubMedGoogle Scholar
  7. Bonevski B, Sanson-Fisher RW, Campbell E, Carruthers A, Reid ALA, Ireland M (1999) Randomized controlled trial of a computer strategy to increase general practitioner preventive care. Prev Med 29:478–486CrossRefPubMedGoogle Scholar
  8. Brand DA, Saisana M, Rynn LA, Pennoni F, Lowenfels AB (2007) Comparative analysis of alcohol control policies in 30 countries. PLoS Med 4:e151CrossRefPubMedGoogle Scholar
  9. Breen C, Shakeshaft AP, Doran CM, Sanson-Fisher RW, Mattick RP (in press) The cost-effectiveness of postal surveys in improving survey response rates: a randomised controlled trial. Aust N Z J Public HealthGoogle Scholar
  10. Breen C, Shakeshaft A, Slade T, Love S, D’Este C, Mattick R (under review). Do community characteristics predict alcohol-related crime?Google Scholar
  11. Casswell S, Gilmore L (1989) An evaluated community action project on alcohol. J Stud Alcohol 50:339–346PubMedGoogle Scholar
  12. Collins D, Lapsley H (2008) The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. National Drug Strategy Monograph Series No. 64. Canberra, Commonwealth of AustraliaGoogle Scholar
  13. Cook WK (2008) Integrating research and action: a systematic review of community-based participatory research to address health disparities in environmental and occupational health in the USA. J Epidemiol Community Health 62:668–676CrossRefPubMedGoogle Scholar
  14. Czech S, Shakeshaft AP, Byrnes J, Doran CM (in press) Counting the cost of alcohol-related traffic crashes: is the public health burden of harm greater in rural or urban environments? Accid Anal PrevGoogle Scholar
  15. Dent CW, Grube JW, Biglan A (2005) Community level alcohol availability and enforcement of possession laws as predictors of youth drinking. Am J Prev Med 40:355–362CrossRefGoogle Scholar
  16. Dunne MP, Martin NG, Bailey JM, Heath AC, Bucholz KK, Madden PAF, Statham DJ (1997) Participation bias in a sexuality survey: psychological and behavioural characteristics of responders and non-responders. Int J Epidemiol 26:844–854CrossRefPubMedGoogle Scholar
  17. Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, Kwan I (2002) Methods to influence response to postal questionnaires (Cochrane Methodology Review). In: The Cochrane Library, Issue 4Google Scholar
  18. Furnham A (1986) Response bias, social desirability and dissimulation. Pers Individ Dif 7:385–400CrossRefGoogle Scholar
  19. Galea S, Tracy M (2007) Participation rates in epidemiologic studies. Ann Epidemiol 17:643–653CrossRefPubMedGoogle Scholar
  20. Giesbrecht N, Krempulec L, West P (1993) Community-based prevention research to reduce alcohol related problems. Alcohol Health Res World 17:84–90Google Scholar
  21. Godin G, Belanger-Gravel A, Eccles M, Grimshaw J (2008) Healthcare professionals’ intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci 3Google Scholar
  22. Green L, Marshall W (2002) Fighting back or fighting themselves? Community coalitions against substance abuse and their use of best practices. Am J Prev Med 23:303–306CrossRefPubMedGoogle Scholar
  23. Hawkins NG, Sanson-Fisher RW, Shakeshaft AP, D’Este C, Green L (2007) The multiple baseline design for evaluating population-based research. Am J Prev Med 33:162–168CrossRefPubMedGoogle Scholar
  24. Hingson R, McGovern T, Howland J, Heeren T, Winter M, Zakocs R (1996) Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program. Am J Public Health 86:791–797CrossRefPubMedGoogle Scholar
  25. Holder HD, Gruenewald PJ, Ponicki WR, Treno AJ, Grube JW, Saltz RF, Voas RB, Reynolds R, Davis J, Sanchez L, Gaumont G, Roeper P (2000) Effect of community-based interventions on high-risk drinking and alcohol-related injuries. JAMA 284:2341–2347CrossRefPubMedGoogle Scholar
  26. Homel R (1994) Drink-driving law enforcement and the legal blood alcohol limit in NSW. Accid Anal Prev 26:147–155CrossRefPubMedGoogle Scholar
  27. Judd F, Jackson H, Korniti A, Murray G, Fraser C (2007) Service utilisation by rural residents with mental health problems. Australas Psychiatry 15:185–190CrossRefPubMedGoogle Scholar
  28. Kaner EF, Beyer FR, Dickinson HO, Pienaar ED, Campbell F, Schlesinger C, Heather N, Saunders JB, Burnand B (2007) Effectiveness of brief alcohol interventions in primary care populations (Review). Cochrane Database Syst Rev 2:1–97Google Scholar
  29. Korkeila K, Suominen S, Ahvenainen J, Ojanlatva A, Rautava P, Helenius H, Koskenvuo M (2001) Non-response and related factors in a nation-wide health survey. Eur J Epidemiol 17:991–999CrossRefPubMedGoogle Scholar
  30. Merzel C, D’Afflitti J (2003) Reconsidering community-based health promotion: promise, performance, and potential. Am J of Public Health 93:557–574CrossRefGoogle Scholar
  31. Moyer A, Finney JW, Swearingen CE, Vergun P (2002) Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 97:279–292CrossRefPubMedGoogle Scholar
  32. Ockene JK, Edgerton EA, Teutsch SM, Marion LN, Miller T, Genevro JL, Loveland-Cherry CJ, Fielding JE, Briss PA (2007) Integrating evidence-based clinical and community strategies to improve health. Am J Prev Med 32:244–252CrossRefPubMedGoogle Scholar
  33. Perry CL, Williams CL, Veblen-Mortenson S, Toomey TL, Komro KA, Anstine PS, McGovern PG, Finnegan JR, Forster JL, Wagenaar AC, Wolfson M (1996) Project Northland: outcomes of a community-wide alcohol use prevention program during early adolescence. Am J Public Health 86:956–965CrossRefPubMedGoogle Scholar
  34. Petrie D, Doran CM, Shakeshaft A, Sanson-Fisher RW (2008) The relationship between alcohol consumption and self reported health status using the EQ5D. Soc Sci Med 67:1717–1726CrossRefPubMedGoogle Scholar
  35. Pidd K, Berry JG, Harrison JE, Roche AM, Driscoll TR, Newson RS (2006) Alcohol and work: patterns of use, workplace culture and safety. AIHW, CanberraGoogle Scholar
  36. Sackett D, Rosenberg M, Gray J, Haynes R, Richardson W (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312:71–72PubMedGoogle Scholar
  37. Saltz R (1987) The roles of bars and restaurants in preventing alcohol-impaired driving. Eval Health Prof 10:5–27CrossRefGoogle Scholar
  38. Saltz R (1989) Research needs and opportunities in server intervention programs. Health Educ Q 16:429438Google Scholar
  39. Sanson-Fisher RW, Bonevski B, Green LW, D’Este C (2007) Limitations of the randomized controlled trial in evaluating population-based health interventions. Am J Prev Med 33:155–161CrossRefPubMedGoogle Scholar
  40. Schinke SP, Tepavac L, Cole KC (2000) Preventing substance use among native American youth: three-year results. Addict Behav 25: 387–397Google Scholar
  41. Shakeshaft A, Bowman J, Sanson-Fisher R (2002) Community-based drug and alcohol counselling: who attends and why? Drug Alcohol Rev 21:153–162CrossRefPubMedGoogle Scholar
  42. Slater MD, Kelly KJ, Edwards RW, Thurman PJ, Plested BA, Keefe TJ, Lawrence FR, Henry KL (2006) Combining in-school and community-based media efforts: reducing marijuana and alcohol uptake among younger adolescents. Health Educ Res 21:157–167Google Scholar
  43. Straus S, Richardson W, Glasziou P, Haynes R (2005) Evidence-based medicine: how to practice and teach EBM. Churchill Livingstone, LondonGoogle Scholar
  44. Stout RL (1992) Prevention experiments in the context of ongoing community processes: opportunities or obstacles for research. In: Holder HD, Howard JM (eds) Community prevention trials for alcohol problems: methodological issues. Praeger Publishing, Westport, Conn., pp 121–133Google Scholar
  45. Stout RL (1994) Conclusions. In: Final report of the Rhode Island community alcohol abuse and injury prevention project: report to national institute on alcohol abuse and alcoholism. Vol 2. Providence: Rhode Island Dept of Health 9:1–9Google Scholar
  46. Van Loon AJM, Tijhuis M, Picavet HSJ, Surtees PG, Ormel J (2003) Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol 13:105–110CrossRefPubMedGoogle Scholar
  47. Vijayaraghavan R, Soundararajan V (1998) Design and evaluation of skip-lot sampling inspection plans with double-sampling plan as the reference plan. J Appl Stat 25:341–348CrossRefGoogle Scholar
  48. Voas RB, Hause JM (1987) Deterring the drinking driver: the Stockton experience. Accid Anal Prev 19:81–90CrossRefPubMedGoogle Scholar
  49. Wagenaar AC, Gehan JP, Jones-Webb R, Toomey TL, Forster JL, Wolfson M, Murray DM (1999) Conference Information: 4th Symposium on Community Action Research and the Prevention of Alcohol and Other Drug Problems, Feb 08–13, 1998 Russell, New Zealand. J Community Psychol 27: 315–326Google Scholar
  50. Webb G, Shakeshaft AP, Sanson-Fisher RW, Havard A (2009) A systematic review of workplace interventions for alcohol-related problems. Addiction 104:365–377CrossRefPubMedGoogle Scholar
  51. Wutzke SE, Shiell A, Gomel MK, Conigrave KM (2001) Cost effectiveness of brief interventions for reducing alcohol consumption. Soc Sci Med 52:863–870CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Suzanne Czech
    • 1
  • Anthony P. Shakeshaft
    • 1
  • Courtney Breen
    • 1
  • Robert W. Sanson-Fisher
    • 2
  1. 1.National Drug and Alcohol Research Centre (NDARC)University of New South Wales (UNSW)SydneyAustralia
  2. 2.School of Medicine and Health ScienceUniversity of NewcastleNewcastleAustralia

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